Humana Delays 93 Year Old's Medicine For 3 Weeks

By consumerist.comFebruary 11, 2008

John writes:

Had a problem with my Mom’s Medicare Part D Prescription Drug plan with Humana. Their mail order pharmacy (RightSource) advertises a two-week turnaround from date of sending-in an order to receipt of medications. However after three weeks, RightSource had not acknowledged receipt of the order. A RightSource phone rep said the logging-in of orders was being delayed by two to three weeks due to heavy volume. This delay — in the case of meds for a 93 year-old lady — was unacceptable.

I was able to find the email address for Humana’s CEO Michael B. McAllister (who last year earned $3.33 million in compensation). The email is mmccallister@humana.com.

I sent him an email which began with “Congratulations on Humana’s record-breaking 2007 performance in membership, revenue and profit.” I then explained my Mom’s problem and asked for assistance.

Within 24 hours I received an email from a customer care representative at Humana apologizing for the problem, telling me that my Mom’s order had been located and that the order was being over-night shipped.

That’s fantastic! The power of taking it to the top. Hope your mom’s medicine arrived swiftly and she is doing well.

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I do not trust mail order pharmacies. Why would you want to wait for your prescriptions to be mailed to you? My MIL has the Medicare part D as well as our state (IL) Seniors RX plan and we get her blood pressure and other meds from Walgreens when we want and her highest copay is only $5.50, most are only $2.00.

@DeltaPurser: my job involves helping people get their meds through mail order pharmacies and often, insurance restrictions keep them from reordering until the last minute. even if it was a ‘new’ prescription, it was probably a renewal of a pre existing prescription and therefore subject to a reorder timeline.

I don’t know how Medicare works exactly, so is the mail ordering pharmacy a normal thing? I mean, my first thought was, “why the heck would you trust the mail to do it for you?” when you can just go to CVS or Walgreens.

@DeltaPurser: Because many of these places won’t accept a re-order until most of the medication is gone, usually about 75% of it. So you can’t order too far ahead. This causes a huge problem if a mail order pharmacy gets behind.

Some health plans tell you up front you have to use their mail order option to get the lower priced copays. Many of them also have agreements to get your mail order price at certain pharmacies. But they tend to underplay this or outright not tell people.

Like if your health plan uses Express Scripts you can get 90 day refills at Walgreens or Target for the same price as doing them through the mail order version of Express Scripts. But most plans don’t even mention it in the plan book. I had to ask to find this out.

@jacknval: It is often cheaper and easier to mail order meds. I know that about five years back I had a lot of trouble with filling three month prescriptions for my meds. I can’t remember if local pharmacies refused to fill for that length of time or what the exact issue was, but filling it through a mail order service worked perfectly.

Due to heavy phone volume? So presumably, this Humana plan was chosen by the insured, or, is does Medicare require you to use certain providers/presription services? If so, can you imagine the nightmare of universal healthcare? Infinite demand on finite resources. “Heavy phone volume” will become a part of everyone’s lives.

I wonder if they only accept prescription refills so many days in advance? I know our insurance will only approve refills when X number of days are left on the current prescription. I can put it “on file” at the pharmacy and pick it up but still…this is scary and could happen to anyone.

For one of my medications, a pill that I take every day, mail order is the only way to go. It’s a little bit of a pain to set up, but once it gets going, it’s amazing. I get a 90 day supply of my medications every 3 months.

I actually use Anthem BCBS’s mail order service. I accidentally forgot to call to get a refill just a few weeks ago, and the refill expired (you only have 2 weeks from when you run out of pills to when it expires). I called, and the response was “No problem”. They called my doctor, got a new prescription, and my pills were in my mailbox a week later.

For a quick 2 week course of medications, mail order isn’t always the way to go, but for something that you are taking for a long time, I can’t think of a better way to do it.

My insurance will pay for you to have your prescription filled if it is a one-off (like antibiotics) or up to 3 times if it is a new-to-you medicine that you will be taking permanently or semi-permanently (to see if you can tolerate it or to see if it works, I’m guessing).

But after 3 fills, you *have* to send it in or they won’t pay.

For prescriptions on the Wal-Mart/Target/K-mart $4.00 plan, which covers hundreds of regularly prescribed meds, I just pay it myself – it’s cheaper to just pay the $4.00.

But for meds that have to be taken daily that are more than $4.00, it’s cheaper to mail them in (and it’s the only way you’ll get them covered). But the trick is you have to wait until almost the last moment to get them. Basically, when you have a few weeks left, you are supposed to re-order. You are not allowed to re-order before then.

It requires a lot of management on the prescription-holder’s part (or on the part of their caregiver), but that is standard anymore. Implicit in this *should* be the agreement that if they can’t uphold their end of the bargain – getting your meds back to you in a timely fashion – you should be able to go straight to a local pharmacy and get your prescription filled.

As an ex-retail pharmacist, I can safely say this is the norm with mail-order. Many (most?) insurance companies require it on maintenance medications. As others have said, it requires a bit of planning ahead on the patient’s part, but just as often the mail order companies fall behind.

Chain pharmacies hate the mandatory mail order & have tried (sometimes successfully) to sue the insurance companies, forcing the insurance companies to let the chains attempt to match prices on contracts with the mail order companies.

At some point, a senator’s grandmother will die when she goes without her beta blocker for 3 weeks when mailorder screws up. It’s sad, but that’s what it’s going to take to get any attention paid to this matter.

As mentioned and which is a problem with many insurances is that they do not let you reorder till you are practically almost out. They make it impossible for you to stock up on prescriptions in case of something like a hurricane for example.

In case of the $4 prescriptions, you don’t need insurance and you can refill at your own leisure.

@UpsetPanda: This has nothing to do with Medicare. It has to do with Humana. Medicare does not require mail scripts.

The trick about Part D (the drug benefit)is that it can be offered by any insurance company, as long as it meets a base level of benefits.

The reason that they want people to use mail order services is because it costs the insurance company less for the drugs. Many insurance companies that offer Part D plans require it for maint. medications.

I’d also suggest a complaint be lodged with your congressperson and senator. You can call their local offices and ask to be transferred to the DC office. What you’ll then need to do is ask for the “LA that handles healthcare issues”. Tell them what’s going on and ask them if there is any legislation pending that might change anything.

@jacknval: Since my meds can now be gotten for $4/mo at Target, I go there, but my previous health insurance offered a 3 months supply for $10. If I went to CVS to pick it up on my insurance, it’d be $10 for 1 month. Since I took the meds monthly for 12 months out of the year, yeah, it made sense to mail order them.

Reason I don’t do it now is my new health insurance copay is $15 rather than $10 for the 3 months. So it’s cheaper to do it without insurance at Target at $12 for 3 months. :-)

I use ccs medical for my diabetes testing supplies. And everything went great in the beginning when I was only testing once a day. But when I was put on insulin I started testing 4 times a day. My doctor called and gave them a verbal ok on the new script and they still wouldn’t send it. I called them 4 times in 2 weeks trying to get it straightened out an I still don’t have my supplies, although they have been shipped.
At one point I was on the phone with a rep when and she was reading back to me some of the previous actions on my account and said “your doctors office called and gaves us a verbal order for your supplies” Then within 2 sentences she said “if we had a verbal oder we could send you some to get you buy until the paper work is done correctly” ! I about fell out of the chair. I said “didn’t you just tell me my doctors office called and gave that order? Because if that isn’t a verbal confirmation I don’t know what it is you need.”
Fortunately things went smoothly after that.
Dealing with the part d insurance sucks and is a huge pain in the ass. I am a reasonably intelligent person and with several severe disabilities and I can just about wade through the crap that you have to go through to get anything done.
I can’t imagine how people who are older and or have a mental impairment get through it.
I often think they do this crap just to get you to take what they give you and be happy about it.

@ShadowFalls: This is what annoys me about the refill restrictions via insurance. They won’t let you get ahead so unless you just got all your 90 day prescriptions in hand you could potentially be SOL in a disaster. Even if you had the cash to pay out of pocket (some are hundreds per script) you would have to be able to get to a pharmacy and it would need to be open. If your not with a chain you could be totally SOL.

At some point, a senator’s grandmother will die when she goes without her beta blocker for 3 weeks when mailorder screws up. It’s sad, but that’s what it’s going to take to get any attention paid to this matter.

Then we are sooo screwed. Senators have grandkids and great-grandkids, not grandmothers. (Some probably don’t have mothers, or tossed them in front of busses to win election, but that’s not my point.)Our only luck is to hold out for the Senators themselves to miss their mail-order beta-blockers…

I work with Rightsource everyday and the past month has been nothing but this same exact thing over and over. This lady is very lucky getting her prescriptions in just over 3 weeks. There are some people who mailed prescriptions into Rightsource over a month ago and are still waiting. You would think that the prescriptions may have been lost in the mail, but you can prove they weren’t when a check to pay for the prescriptions is mailed in the same envelope and has been cashed by Rightsource Three weeks ago. I am just very surprised that nobody has filed a class action law-suit against Rightsource.

@bohemian: I used to use walgreens for Express Scripts and they randomly decided not to pay for my prescription one day, claiming they don’t cover refills unless I use the mailorder pharmacy. Which is bull, bc I’d been getting refills from there for months.

i work for a pharmaceutical manufacturer for a VERY expensive medication. [my part D patients hit the donut hole in january or february] sadly, there’s no generic. not going to get in an argument over that, i don’t price the meds, nor manufacture them.

a portion of my job involves talking to my patients and finding out if they are having trouble getting their medication. sometimes it’s something they can sort out, sometimes it’s a delay we can compensate for by sending out free ones to the patient, sometimes i get to sort it out by getting on the line with the pharmacy and/or doctor’s office.

some things to keep in mind:
the person on the phone with you is NOT a pharmacist. it’s a CSR. i had my own issues with Express Scripts cancelling a prescription last month because my doctor sent it in before the insurance company let the reorder go through. they didn’t cancel the ORDER, they cancelled the whole prescription by mistake! the CSR wanted me to go back to my doctor and get a new one. um… no. i had them get the pharmacist on the line with me on hold…. oopsie! looks like we can fill that after all.
sometimes it takes making someone go PULL THE PAPER OUT OF THE PILE and look at it.

also – if you ever DO need to order in advance of your refill because you are going to be out of town or something, ask your insurance company [well in advance] for a ‘vacation override.’ this usually takes several [4-6] weeks to process but if you are off to study abroad or joining a kibbutz for a while, it’s the most worry free way to go.

and if your medication manufacturer has a help desk – there is really nothing like the power of having the good CSR working for you. sometimes we have the supersecret phone numbers, fax numbers and a pre-existing relationship with the person at the pharmacy.

Spouse sent in her and my prescriptions, as well as credit card #, as was required by Humana paperwork. They lost her prescription, the credit card #, and refused to process it when called, by us after realizing, her’s had not been processed. Of course it was late by then, but they still didn’t care. They refused to process her’s until I gave them the Credit Card # over the phone, which I did not want to do for security reasons (cordless phones can be monitored by scanners). They did not care if she got her med.s, which were all ready late, by their own stupidity, and negligence. I demanded an apology for their losing my credit card # (which can lead to identity theft). They refused, and refused to explain why not. These idiots have the prescriptions handled in Arizona( probably using illegal aliens), Finance in Colorado or Indiana, and head office somewhere else, and they cannot communicate with each other over computer. They have to phone, and do not update info., to each other in an expediant manner, which causes more harrassment to us. If I did not have to use these numbskulls, I would definitely be going elsewhere, but since I am stuck, I can only contact my congressman, which is parly responsible, anyway.
If you have any options at all, stay away from this disaster.